IOS Press Cultural factors inﬂuencing performance on ...

Behavioural Neurology 23 (2010) 245–247 245DOI 10.3233/BEN-2010-0306IOS Press

Cultural factors influencing performance onvisuoperceptual neuropsychological tasks

Mary H. Kosmidis∗, Stella Tsotsi, Olympia Karambela, Eleni Takou and Christina H. VlahouSchool of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece

1. Introduction

Recent years have seen a growing interest in neu-ropsychological assessment throughout the world. Incountries with no history of neuropsychological re-search, clinicians often use existing tests developed inother countries with a long tradition in neuropsycho-logical research and practice. While verbal tests wereviewed as vulnerable to cultural and/or language bias,visuoperceptual tasks were once considered impervi-ous to cultural factors. More recent studies, however,have dispelled this myth [1]. For example, ColombianAruacos showed significantly poorer performance onthe Rey-Osterrieth copy and immediate memory condi-tions [2] and Turkish undergraduate students achievedlower scores than an American normative sample onthe Group Embedded Figures Test, approaching thetask with a unique cognitive style [3]. Even withinthe same country, ethnic or racial minorities may al-so be influenced by cultural factors. For example, inthe U.S., elderly Spanish-speaking Americans achievedlower scores than English-speaking peers on the Ben-ton Visual Retention Test and Identities and Oddities(Mattis Dementia Rating Scale) [4].

Culture-based influences on neuropsychologicalper-formance most likely reflect underlying assumptionsregarding not only which functions are worthy of as-sessment, but also the optimal approach to assessingthem. More specifically, implicit beliefs and value

∗Corresponding author: Mary H. Kosmidis, School of Psy-chology, Aristotle University of Thessaloniki, 54124 Thessaloniki,Greece. Tel.: +30 2310 997308; Fax: +30 2310 997384; E-mail:[email protected].

judgments may emphasize the importance of particu-lar abilities over others (e.g., verbal vs. interpersonalskills), they ways in which these abilities should man-ifest (e.g., speedy responding vs. power tests) andthe actual nature of the function (e.g., school learningvs. novel problem-solving). In the present investiga-tion, we sought to evaluate the cultural appropriatenessof several commonly used neuropsychological tests ofvisuoperceptual skills and to identify components ofthese tests that might limit their appropriateness for theGreek population. Additionally, we sought to proposea method for exploring the cultural appropriateness ofneuropsychological tests relevant to other countries andethnic minorities.

2. Method

We recruited healthy Greek individuals from the fulladult age range from the community to participate inseparate studies for the development of normative da-ta. Exclusion criteria were a (self-reported) history ofpsychiatric or neurological disorder, substance abuseor dependence, head injury or any other medical dis-order affecting the central nervous system, based ontheir self-report. All participants gave written informedconsent. The visuospatial tests were administered toeach participant individually according to standardizedprocedure (see Table 1 for the tests administered). Wethen found normative or lifespan studies conducted inthe U.S. or the U.K. to use as comparison groups [5–10]. For these comparisons, we used a subset of eachof our samples so as to match them with the foreignsamples according to age range.

ISSN 0953-4180/10/$27.50 2010 – IOS Press and the authors. All rights reserved

246 M.H. Kosmidis et al. / Cultural factors in visuoperceptual tasks

Table 1

Greek British AmericanMean S.D. Mean S.D. Mean S.D.

VOSP (n = 58) (n = 160) (n = 111)Silhouettes 12.7 1.8 18.8 1.4 19.5 0.7Incomplete Letters 16.7∗ 4.5 22.2 4.0 20.4 3.8Object Decision 15.0∗ 2.8 17.7 1.9 17.5 1.9Progressive Silhouettes 11.8∗ 2.6 10.8 2.5 9.6 2.2Dot Counting 9.8 0.6 9.9 0.2 9.8 0.6Position Discrimination 19.5 0.8 19.6 0.9 19.5 1.3Number Location 6.7∗ 2.9 9.4 1.1 9.1 1.3Cube Analysis 7.5∗ 2.4 9.2 1.2 9.5 0.8

HVOT 18.3∗ (n = 88) 4.6 26.2 (n = 222) 2.6JLO M W M W16–49 years 27.5∗ (n = 42) 3.1 25.0 (n = 43) 4.3 25.6 (n = 27) 3.1 23.3 (n = 31) 4.350–64 years 25.0 (n = 20) 3.7 23.8 (n = 18) 3.7 24.3 (n = 17) 3.7 22.2 (n = 26) 3.765–74 years 24.2 (n = 10) 3.2 16.7 (n = 9) 6.2 22.7 (n = 21) 3.2 20.8 (n = 15) 6.2FR60–69 years 44.6 (n = 21) 4.6 42.8 (n = 101) 4.070–79 years 38.2 (n = 12) 5.2 40.6 (n = 99) 4.0R-O30–50 years 34.9∗ (n = 105) 1.6 32.8 (n = 48) 3.150–65 years 33.9∗ (n = 88) 3.5 31.2 (n = 57) 4.465–80 years 29.7 (n = 45) 6.2 31.4 (n = 102) 4.0GEFT 14.1∗ (n = 58) 4.3 12.0 (n = 70) 4.6

3. Results

Results differed based on each test. Our Greek sam-ples performed more poorly than both comparisongroups on most subtests of the (VOSPT) subtests. Inparticular, Greek adults performed more poorly on Sil-houettes [Greek vs. British:t(216)= 8.653,p < 0.05;Greek vs. American:t(167)= 5.641,p < 0.05], Ob-ject Decision [Greek vs. British:t (216)= 8.13,p <

0.05; Greek vs. American:t(167)= 7.02,p < 0.05],Progressive Silhouettes [Greek vs. British:t(216) =

2.55,p < 0.05; Greek vs. American:t(167)= 5.70,p < 0.05], Number Location [Greek vs. British:t(216)= 9.89, p < 0.05; Greek vs. American:t(167) =

7.26,p < 0.05], and Cube Analysis [Greek vs. British:t(216)= 6.87,p < 0.05; Greek vs. American:t(167)= 2.97,p < 0.05], but not on Dot Counting and Posi-tion Discrimination. The Greek sample also performedworse than the comparison group on the Hooper Vi-sual Organization Test (HVOT) [t(308)= 19.06,p <

0.05]. No group differences emerged on the Judgementof Line Orientation (JLO), with the exception of betterperformance of the Greek, relative to the American,young male group (age group 16–49 years) [t(67) =

2.48,p < 0.05]. Performance was also similar betweenthe two samples on the Face Recognition (FR) [agegroup 60–69:t(120) = 1.90, p > 0.05; aged 70–79t(109)= 1.92,p > 0.05]. Finally, the group differenceon the (R-O) copy [t(392)= 9.80,p > 0.05] and the

Group Embedded Fiqures Test (GEFT) [t(126)= 2.65,p > 0.05] favored the Greek over the American sample.

4. Discussion

The findings of the current study indicated poorerperformance of the Greek sample as compared withpublished studies from the U.S. and the U.K. on somevisuospatial tasks, namely the VOSPT and the HVOT,but similar performance on others, such as the JLO andthe FR, with a definite Greek advantage on the R-Oand the GEFT. We propose that tests requiring a certainlevel of abstraction in order for an examinee to respondcorrectly (i.e., VOSPT, HVOT) may yield lower scoresin the Greek sample when compared with samples fromstudies in other countries. In contrast, tests callingfor more concrete perceptual skills yielded similar re-sponses between Greek and foreign samples. Finally,better performance on tests requiring the processing ofgeometric shapes may reflect the extensive exposure togeometry in the Greek as compared to the Americanschool system.

Limitations to the generalizability of our findingsemerge from the post hoc nature of our study, as wellas the lack of data from the full adult range and infor-mation on educational level in some of the comparisonsamples. Our next step is to explore the ability of thesetests to correctly classify patients and healthy individ-

M.H. Kosmidis et al. / Cultural factors in visuoperceptual tasks 247

uals in order to establish their clinical utility for theGreek population.

Our current findings highlight the importance of ex-ploring the component features of existing tests in orderto exclude features that may complicate the assessmentof a particular skill in a given cultural group, insteadof merely developing norms for existing foreign tests.This process may aide in the design and developmentof new, culture-appropriate tests. We believe that thecultural appropriateness of specific neuropsychologicaltests remains an empirical question.

Acknowledgement

The present study was supported by a Marie CurieInternational Reintegration Grant (7th Framework Pro-gramme)

References

[1] I. Herrera-Guzman, J. Pena-Casanova, J.P. Lara, E. Gudayol-Ferre and P. Bohm, Influence of Age, Sex, and Education onthe Visual Object and Space Perception Battery (VOSP) In aHealthy Normal Elderly Population,The Clinical Neuropsy-chologist18 (2004), 385–394.

[2] M. Rosselli and A. Ardila, The impact of culture and educationon non-verbal neuropsychological measurements: a criticalreview,Brain and Cognition52 (2003), 326–333.

[3] M. Cakan, Psychometric data on the Group Embedded FiburesTest for Turkish undergraduate students,Perceptual and MotorSkills96 (2003), 993–1004.

[4] D.M. Jacobs, M. Sano, S. Albert, P. Schofield, G. Dooneiefand Y. Stern, Cross-cultural neuropsychological assessment:a comparison of randomly selected, demographically matchedcohorts of English- and Spanish-speaking older adults,Jour-nal of Clinical and Experimental Neuropsychology19 (1997),331–339.

[5] A. L. Benton, A. B. Sivan, K. deS. Hamsher, N.R. Varney andO. Spreen,Contributions to Neuropsychological Assessment.A clinical manual(2nd ed.), Oxford University Press, NewYork, 1994.

[6] P.J. Bonello, L.J. Rapport and S.R. Millis, Psychometric Prop-erties of the Visual Object and Space Perception Batteryin Normal Older Adults,The Clinical Neuropsychologist11(1997), 436–442.

[7] K.J. Christensen, B.E. Riley, K.A. Heffernan, S.B. LoveandM.E. McLaughlin Sta. Maria, Facial recognition test in the el-derly: norms, reliability and premorbid estimation,The Clin-ical Neuropsychologist16 (2002), 51–56.

[8] A.L. Cummings and H.G. Murray, Psychometric data on theGroup Embedded Figures Test for a sample of adult learners,Perceptual and Motor Skills65 (1987), 583–586.

[9] P.S. Fastenau, N.L. Denburg and B.J. Hufford,. Adult normsfor the Rey-Osterrieth Complex Figure Test and for Supple-mental Recognition and Matching Trials from the Extend-ed Complex Figure Test,The Clinical Neuropsychologist13(1999), 30–47.

[10] A.L. Jefferson, S. Wong, E. Bolen, A. Ozonoff, R.C. Greenand R.A. Stern, Cognitive correlates of HVOT performancediffer between individuals with mild cognitive impairmentand normal controls,Archives of Clinical Neuropsychology21(2006), 405–412.

Submit your manuscripts athttp://www.hindawi.com

Stem CellsInternational

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014

Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinson’s Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

IOS Press Cultural factors inﬂuencing performance on ...

Documents

Transcript of IOS Press Cultural factors inﬂuencing performance on ...